Global Survey of Latent Tuberculosis Screening and Treatment Practices in Liver Transplantation

We surveyed transplant and infectious disease (ID) practitioners to better understand approaches to managing latent tuberculosis infection (LTBI) in liver transplantation (LT), an area in which high-quality evidence is lacking. The survey was distributed to clinicians via international ID society listservs, and one respondent per transplant center was requested. There were 86 respondents, including 78 (91%) ID physicians, from North America (68%), Europe (12%), South America (11%), Asia (7%), Africa (1%), and Australia (1%). Most centers (92%) screen all LT candidates for LTBI, and 95% use tuberculosis (TB) interferon-gamma release assays (TB-IGRA) as first-line. In LT recipients with indeterminate TB-IGRA results, respondents differ in terms of which specific TB risk factors may impact treatment decisions. Timing of post-transplant LTBI treatment varies with only 27% choosing to initiate therapy during the index transplant admission. The majority of respondents (88%) prescribe isoniazid monotherapy to LT recipients with LTBI for 6 (23%) or 9 (65%) months. Management of living donor LTBI differs depending on severity of liver disease in the potential recipient. These survey data will inform future collaborative research efforts to optimize LTBI management in LT.